NR 603 WEEK 5 IHUMAN CASES RESPONSES COMPLETE SETS FOR 2023
CC: Pain to foot
PMHx: overweight no other significant history. Family history father is
... [Show More] obese and had gastric
bypass surgery x1year ago no other significant history for the family. Does not smoke, drink
ETOH or caffeine or use illicit drugs
Demographics: 16-Year-old Hispanic male, high school student, lives with both parents and has
insurance
Medications: Multi-Vitamin
PSHx: none reported
Allergies: NKDA
Lifestyle: participates in school football and weightlifting
HPI: DG is a 16-year-old Hispanic male who presented to the clinic with father c/o left foot pain
reporting that a 40 lb. Dumbbell slipped out of his hand while lifting weights at the school gym x
2 days ago. Initially did not hurt but upon returning home from school after the workout, it began
to hurt describing the pain as throbbing to the left top of the foot. Able to bear weight only
complains of 3 out of 10 on the pain scale. Aggerating factors are weight bearing and unable to
put on tennis show. Denies any ice, elevation or wrapping the extremity and the no additional
medication for pain.
Associated risk factors/ demographics contributing to foot pain- pain to the left foot
associated risk factors contributing to the chief complaint physical activity due to lifting weights
and inability to repeatedly lifting the weight and maintain control of the weight due to
unsupported strength. Inappropriate shoes for the specific activity.
Differential Diagnosis represented by CC including pathophysiology and rationale
Stress fracture
1. Pathophysiology: When a bone is broken the periosteum and blood vessels in the cortex,
marrow, and surrounding soft tissues are disrupted. Bleeding occurs from the damaged
ends of the bone and from the neighboring soft tissue. A clot (hematoma) forms within
the medullary canal, between the fractured ends of the bone. (McCance, 2015).
2. Rationale: it is activity induced there is also discomfort with activity, tenderness to dorsal
aspect of the foot, occurred with trauma
Tendinitis
1. Pathophysiology: Symptomatic degeneration of the tendon with vascular disruption and
inflammatory repair response. inflammatory fluid accumulates causing swelling of the
tendon and its enclosing sheath (McCance, 2015). Inflammatory changes cause
thickening of the sheath, which limits movements and causes pain. Microtears cause
bleeding, edema, and pain in the involved tendons or surrounding structure.
2. Rationale: discomfort, tenderness and mild swelling to the left dorsal medial aspect of the
foot.
Sprain
1. Pathophysiology: When a tendon or ligament is torn, an extensive cascade of
inflammatory processes begins. An inflammatory exudate develops between the torn
ends. Later, granulation tissue containing macrophages, fibroblasts, and capillary buds
grows inward from the surrounding soft tissue and cartilage to begin the repair process
(McCance, 2015). Within 3 to 4 days after the injury, collagen formation begins. At first,
collagen formatio [Show Less]